Substernal Goiter

[dawn1958]

In Sep 2004 I was diagnosed with a large diffuse, multi-nodular goiter that was termed "below the breastbone".  My family doctor suggested suppressive therapy to shrink it and said it would be a four to five year process before it resumed a normal size.  I was put on Synthroid 175mg, which did not work well, as I still had a lot of hypo symptoms after two years of treatment.  

In Sep 2006 I was switched over to Armour, eventually working up to 3 grains per day in the colder months and 2 and 1/2 grains per day in the warmer months.  At the time of this switch the family doctor felt my neck and said he thought my thyroid was shrinking and that the treatment was working.  I continue to have a sense of fullness in my throat, hoarse voice and difficulty breathing when lying down.  It's better than it was four years ago, but by no means gone.

This last Friday 3/13/09, I went to the ER to be examined after being rear-ended on the freeway.  I had a CT scan of my lower abdomen and a chest x-ray.  The attending physican said the CT scan looked fine, soft tissue swelling and contusion, but that the chest x-ray was abnormal.  He opted to CT scan my chest and the scan revealed, in his words, a massive thoracic goiter.  He said it is pressing on my trachea and an artery.  He has referred me to an endocrinologist and a surgeon.  

My questions:  Does suppressive therapy not always work?  Would my best option be surgery at this point?  Also, I began having severe hyperthyroid symptoms after pregnancy, that eventually ended up in hypothyroid symptoms, some 20+ years later.  Most all my female relatives on my father's side have thyroid problems that manifested after pregnancy.  Could this be Hashimoto's?

Thank you in advance for any comments/advice you can give.
Dawn

[Mark Lupo, M.D.]

Suppressive therapy does not usually work.  You should consult with a surgeon and review the CT scan together so you understand the relationship between the goiter and the surrounding structures: esophagus, trachea, blood vessels, heart.  Surgery is often indicated in these cases.  This could be hashimoto's - testing TPO antibodies could confirm, but this would not change the need for surgical consultation.

[dawn1958]

Thank you Dr. Lupo for you comments!  Your words are confirmation to a consultation I had with a surgeon yesterday.  I have an appointment with another surgeon, just to have a second opinion with another set of eyes looking at the scan.

Thank you again for your help,
Dawn